Mr. Chairman, thank you for the introduction. 
First I would like to congratulate the EBCP in their 10th anniversary on behalf of the Perfusionist’s training school in Leiden. I hope that the EBCP will bring the perfusionist in Europe in the years to come to a higher level of education. I want to talk about how the Nationwide Education Programme in the Netherlands was established and the situation as it is today.

Slide 2 (map Netherlands)

In the Netherlands cardiac surgery nowadays is performed in 13 hospitals of which 8 are university teaching hospitals and 5 are general hospitals. Probably within 2 years the number of general hospitals will be increase to 8. Out of 16 million citizens we performed approximately 16.000 OHO per year. The one to thousand ratio is probably one of the highest in the world.

 Slide 3 (LUMC)

This is the Leiden University Medical Centre, abbreviate LUMC. The LUMC made up of the University Hospital with 800 beds and 3000 employees and the Leiden University Medical School with 4000 employees. Leiden University was founded in 1575 and is the oldest university in the Netherlands.

Slide 4 (amount of ECC for the NeSECC certificate)

Up to 1981 there was no formal training for perfusionists in the Netherlands. No specific qualification was required and the local ECC departments were responsible for the theoretical part of the education. To obtain a NeSECC certificate, students had to write a research project, besides performing a certain amount of extra corporeal procedures. This specific requirements are shown on this slide. There must be 12 specialised procedure performed. The trainees can choose in procedures such as the Bentall procedure, implantation of a ventricular assist device, heart transplantation, aorta arch replacements etc. The training course for clinical perfusionists last approximately three years. In 1981, a theoretical programme for perfusionist was initiated by the Leiden University Medical Centre. Although this programme was not mandatory, half of the hospitals sent their students to this programme. You should keep in mind that the school for perfusionist was initiated by the centre for specialised training at the LUMC and not by the NeSECC. Nevertheless, both parties worked in close cooperation.

Slide 5 (NeSECC logo)

In 1988, the NeSECC decided to establish clinical and educational standards for the perfusionist training. To be eligible for the certificate of the NeSECC, students would have at least a college degree in which physics, chemistry or biology were major subjects. Without this kind of education, application for membership of the NeSECC was denied. For some time it has been the wish of the NeSECC to get official recognition of our profession. To establish this, it was necessary to have a Nationwide Educational Programme. In 1986, the government initiated, on behalf of the NeSECC, the development of a National training programme for perfusionists. After consulting the hospitals directors, NeSECC, the Dutch Society of Cardiothoracic Surgeons and the Dutch Society of Anaesthesiologists, appointed the Dutch National Hospital association, abbreviate NZr, to set up a steering committee. The NZr is an employers federation and represents more than 800 institutions, with more than 230.000 employees. Within the NZr the hospital section got the task of setting this steering  committee.  

Slide 6 (assignments)

Its well known that the Civil Service is not a very fast working institution and  in 1989 this committee was set up. The assignments of this steering committee are shown in this slide. The members of that committee were delegates of the Cardiothoracic surgeons, Anaesthesiologist, NeSECC and of course the division Hospitals of the NZr. This division Hospitals of the NZr has changed its name to Dutch Association of Hospitals, abbreviate NVZ.

Slide 7 (formulation)

Since 1989 this committee has been formulating the educational standards that will guide the training of perfusionist in the future. The slide shows the formulation. 
In 1990, a first concept of the Regulation of a Nationwide Educational Programme for perfusionists, was sent to the hospitals with cardiac surgery programme. After taking into consideration their replies, a second draft was made and presented to the hospitals in June 1991. This was finalised in January 1992.  

Slide 8 (supervisory committee for the education etc.)

Again a new committee was set up by the NVZ, called the supervisory Committee for the Education of Clinical Perfusionists. Main task for this committee was to supervise the quality of the education. This slide shows the members of this committee. It was important for perfusionists to have the maximum number of representatives in the committee.  

Slide 9 (The Individual Health Care Professions Act)

The Certificate of the NVZ is not governed by law. I will now try to explain to you this situation. In November 1993, the upper house of parliament adopted draft legislation concerning the individual health care professions. The individual health care professions act, regulates the provision of care by professional practitioners, focusing on the quality of professional practice and patient protection. Professions can be regulated in two ways, by Act of Parliament section 3, or by an Order in Council pursuant to an Act section 34. Both regulations enable titles to be legally protected: the most important differences are that the government only maintains a register for the professions covered by section 3. The eight professions regulated by section 3 are showed in this slide.

Slide 10 (section 3)

The criteria for registering a profession under section 3 are showed in this slide. The NeSECC applied in 1996 through a body entitled, the Individual Health Care Professions Council, to be covered by the Individual Health Care Profession Act.  This committee made clear that we could not apply for section 3, but perhaps for section 34.  

Slide 11 (section 34)

The criteria applicable to a profession under section 34 are showed in this slide. After the hearing, the committee turned down the application.  Our profession did not fulfil criteria 1 and 3 in this slide. The ministry of health, welfare and sport, confirm in June 1997 that there was no need for registration under the individual healthcare profession act. In the end the government decided to turn down application in the grounds that our profession does not need to be regulated in the same way than the other professions I already showed you.  It was decided that the spirit and content of the act of parliament was not applicable to the perfusionist profession. Nevertheless, the present situation as it is under the NVZ, is satisfactory for the perfusionist in the Netherlands.  

Slide 12 (documents)

Leiden became the national education institute for perfusionist, due to its long-lasting experience. Theoretical education in this institute is now mandatory for all hospitals. There are four important documents for the course. First, the NVZ guidelines, containing the structure and supervision of the course,  standards for the participating hospitals in the practical and theoretical training programme, aims and objectives for the trainings course in the different subjects covered by the programme and entry requirements. Secondly, the syllabus, containing programme aims, programme structure, academic calander, assessments, etc. In order to get a uniform structure of the practical education in every hospital in the country, a logbook called Guidelines For Perfusion Practice, was developed by one of our perfusionists. The logbook was used as a model for the EBCP. In 1996, the first perfusionist was accredited according to the new regulations of the NVZ. The last document is the Programme contents, that goes without saying.

Slide 13 (urenoverzicht)

The minimal number of students, is 5 per course. The hours for the education programme are shown in this slide. During the first two years of this three year programme, students attended classes for 4 days a month. In the third year, a research project is written.  

Slide 14: Subjects

This slide shows the subjects. Here you see the amount of time spent on each subject. We distinguish two kinds of subjects: A and B subjects. This slide shows you the A subjects. Students may not fail in any of these subjects.  

Slide 15 (course)

This slide shows the B subjects. Students may fail in one of these subjects, provided that they compensate with another. As the last three slides shows, most theoretical education is in the first two years of the programme.  

Slide 16 (course)

In this slide you see the remaining subjects. Not printed out are the subjects like evaluation, the study visits and individual support of the research project. At the end of each educational block, there is a written and/or review of the course.

Slide 17 (Consultative bodies)

Two consultative bodies are in charged of theoretical and practical training. One is made up by the head of the departments for extra corporeal circulation, head of the department specialists training and course instructor. The purpose of these meetings is to advice the department of specialists training in aspects relating to structure, content and policy that affect the training course. They other body will hold only after the practical aspects of the training. Their task is to look into the content of the practical training programme and logbook and to advise the former body of their recommendations. Both bodies meet once a year.  

Slide 18

The contribution of the NeSECC to the course is currently limited to the delegation of three members for the Supervision Committee for Education of Clinical Perfusionists, although many experienced members of the NeSECC are involved in the theoretical education in Leiden, teaching “Perfusion Technology”. Establishment of a nation wide education programme, the national registration of clinical perfusionists and the procedure for re-certification, the subject for Peter van den Barselaar in the afternoon session,  has improved patient care as well as improving the performance of the profession in the Netherlands.

Thank you for your attention.